Non-hematologic predictors of mortality improve the prognostic value of the international prognostic scoring system for MDS in older adults

Abstract

Objectives-The International Prognostic Scoring System (IPSS) is commonly used to predict survival and assign treatment for the myelodysplastic syndromes (MDS). We explored whether self-reported and readily available non-hematologic predictors of survival add independent prognostic information to the IPSS. Materials and Methods-Retrospective Disclosures and Conflict of Interest StatementThe authors report no circumstance or competing interest that could be construed or perceived as influencing the interpretation of the results. Dr. Richard M Stone has served in a Consultant or Advisory Role for Genzyme © and has received investigator-initiated research funding from Novartis. Dr. Daniel J. DeAngelo has served in a consultant or advisory role for Novartis ©. Author Contributions Sponsor's RoleThe funders of this project had no role in the design, methods, subject recruitment, data collections, analysis and preparation of paper. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript extracted clinical-pathologic data from medical records. Kaplan-Meier and Cox proportional hazards models were used to estimate survival.Results-One hundred fourteen patients consented and were available for analysis. Median age was 73 years, and the majority of patients were White, were male, and had a Charlson comorbidity score of <2. Few patients (24%) had an IPSS score consistent with lower-risk disease and the majority received chemotherapy. In addition to IPSS score and history of prior chemotherapy or radiation, significant univariate predictors of survival included low serum albumin, Charlson score, performance status, ability to take a long walk, and interference of physical symptoms in family life. The multivariate model that best predicted mortality included low serum albumin (HR = 2.3; 95% CI: 1.06-5.14), therapy-related MDS (HR = 2.1; 95% CI: 1.16-4.24), IPSS score (HR = 1.7; 95% CI: 1.14-2.49), and ease taking a long walk (HR = 0.44; 95% CI: 0.23-0.90).Conclusions-In this study of older adults with MDS, we found that low serum albumin and physical function added important prognostic information to the IPSS score. Self-reported physical function was more predictive than physician-assigned performance status.

Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes

“…This demonstrates that performance scores on their own are insensitive for detecting deficits across patient specific factors or domains that can accumulate and impact on outcomes despite 'good' performance scores. This is consistent with findings in other studies and adds further support to the inclusion of a geriatric assessment in the management of older people with MDS and AML [21][22][23][24][25].…”

Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older

“…The National Comprehensive Cancer Network recommends the incorporation of frailty assessment into the routine care of older cancer patients, to help individualize therapy for the very heterogeneous older population [14]. We have shown in prior work that markers of inflammation such as albumin and self-reported ability to take a long walk are more powerful predictors of survival than disease-specific factors in older patients with hematologic malignancies [15, 16]. …”

Patient‐reported outcome measures in studies of myelodysplastic syndromes and acute myeloid leukemia: Literature review and landscape analysis

“…5,15 Furthermore, their self-reported experience could even provide a reliable prediction for overall survival. 23 Therefore, it is crucial to find the most suitable PROMs that have been validated for use in these patient populations. At the instrument selection stage, several factors should be considered, including disease stage, treatment type, concerns about respondent burden, and the PROMs proven ability to measure HRQOL in the context of these hematological malignancies.…”